Providers identify top three precision medicine challenges

Eighty-four percent of providers agree that precision medicine is relevant to patients’ health and well-being according to a recent survey by HIMSS Analytics, sponsored by Intel [1]. However, implementation of precision medicine initiatives does not come without challenges, according to respondents. Respondents included business leaders, IT leaders, IT professionals and clinicians from organizations ranging in size from fewer than 50 beds to more than 500 beds.

The survey addressed the current and future status of precision medicine initiatives across providers. In response to one survey question, providers identified their top three challenges with respect to implementing precision medicine initiatives. Those challenges, in order of significance, were identified as: (1) budget/financial reasons; (2) issues integrating clinical and genomic data into current systems; and (3) lack of clinical knowledge or expertise.

Budgets limit investments in precision medicine technologies

More than half (55 percent) of respondents identified budget/financial reasons as their primary challenge related to implementing precision medicine. Seventy-one percent placed budget/financial concerns among their top three challenges. A lack of financial resources affects all aspects of implementing precision medicine, from accessing genomic sequencing data, to matching data with treatments, to integrating that information into clinical support.

Several respondents noted that ambiguity around the future of healthcare reimbursement makes them hesitant to invest in new technologies, such as precision medicine, at this time. The CIO of a 500-plus bed provider said: “I think what most provider organizations are struggling with is trying to understand where the reimbursement side is going. What's going to happen with the ACA? The disproportionate share? The bundled payments program? Are provider organizations going to be forced to shift out of fee-for-service into pay-for-performance, and are we prepared to go at-risk for defined populations? I think those are our biggest concerns at the moment.”

On the other hand, some providers view precision medicine as a means to implementing more cost-effective healthcare. The medical director of an intermediate-size hospital (101 to 250 beds) said: “I do think in the short term we will see increased costs with precision medicine. But in the long term, I think it will end up saving money. Because it involves better patient care, we will see fewer side effects associated with non-effective treatments.”

Challenges related to clinical/genomic data integration

Only 7 percent of respondents identified “issues integrating clinical and genomic data into current systems” as their No. 1 concern. However, more than one-third (37 percent) placed this issue among their top three challenges.

Providers who outsource aspects of their precision medicine initiatives, such as using outside genomic sequencing or lab support, sometimes struggle more with data integration than providers who establish a supporting technology infrastructure in-house. That is because when physical samples are sent to an outside lab for processing, the report is often sent back to the provider as a PDF attachment. PDF attachments cannot be entered into EMRs as data points. Nor can they be integrated with clinical decision support tools.

Providers who develop in-house precision medicine practices are often ahead of other providers when it comes to data integration. With the appropriate technology infrastructure in place, they can enter data, such as genomic data, as data points; integrate it into clinical decision support tools; and begin to build an in-house knowledge base that can support the expansion of precision medicine initiatives.

Securing clinical knowledge and expertise

The third greatest challenge respondents identified related to implementing precision medicine was a “lack of clinical knowledge or expertise.” Only seven percent of respondents identified “lack of clinical knowledge or expertise” as their primary concern, yet almost one-third (32 percent) cited the issue among their top three challenges related to precision medicine.

The director of financial operations at a 500-plus bed institution said he sees physician recruitment as a first, essential step in preparing to deliver precision medicine. “You've got to have doctors who can specialize in it before you can really even get the patients in. You can say, ‘Hey, we want to focus in on [precision medicine].’ That's great, but until you have the physicians, that's the key. So, for now, our focus is recruiting the right physicians and getting them the tools they need to be successful.”

He added: “I do think there will be challenges, including reimbursement challenges, in the short-term. But I think in the long-term, precision medicine is going to be beneficial for us. I think it is the future of medicine, and I think everyone understands that.”